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0& <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -gii o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> OWNEFin��h ` /Yl�lr/IL1� VVc�S�P� Jpl�G1E'I� TELEPHONE <br /> HOME ADDRESS �G/j7 ��� - v/ ����D,/ 0 <br /> T • r T ,- m <br /> ° 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME , <br /> 5 z7 31 of las AORES /. /6 r Z <br /> LEGAL DESCRIPTION(see tax receipt) Z - _ Z •O D/ D Lr ✓ �/ yr <br /> VCZD✓ L•D h 0 <br /> CO � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STR CTURE ADDITION c <br /> a <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> e) <br /> n ( <br /> STRUCTURE/ADDITION USE: 1 V I fiP <br /> (Home/Cabin;Commercial Business; Be room;Deck;etc.) 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 ro <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 d 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m Ir <br /> NORTH(N). U) c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. % P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ly 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° <br /> ISSUED. 01 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: I <br /> So <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> Dhvs�(/b sAid �Z 0 r,- <br /> �yor ow mo <br /> 6. �v30I_ <br /> ; <br /> N m <br /> 7. -c- we/ice —o Mvef ®r y: <br /> m <br /> I decla that this application (including any accompanying chedule) has been examined by me and to the best of my ? g p <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o m : M <br /> M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am d <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have cress to th abo a despribecLprernips at any reasonable time for the purpose of inspection. -n <br /> e : <br /> o : <br /> SIGN HERE <br /> igna re of o building c tor) (date) <br /> ZONING ADMINISTRATOR • • • • . h <br /> N in N 44"40 <br /> N f! O t! U1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> L(nC sof T 1()-61_c� <br />